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The Politics of Contraception (and Maternal Mortality)

A conservative (more or less) correspondent wrote to me of his dismay and despair about the freak show that is the Republican Party’s contenders for president. Even though I’m not sure birth control is a right, what do we get out of calling Sandra Fluke a slut and a prostitute? he asked me. That’s a right? We’re going to fight for this? What do we get out of this?

I wrote back to him that to understand why people object to the requirement to include birth control as part of preventative health services, we have to understand something about the nature of human reproduction.

Which is it kills women without modern medical intervention: in absolutely huge, horrendous, terrifying numbers. He’d seen the numbers I put up in Women in the Line of Fire, which estimates 840,429 maternal deaths in America just between 1900 and 1960, vs. 602,451 battle deaths, overwhelmingly of male troops between the Revolutionary and Korean Wars (or 1,079, 245 deaths if you add disease/non-battle deaths to combat deaths). Death in war for men was an episodic tragedy, death in childbirth for women, a constant bloodletting of women in their most economically and intellectually productive years. I once had access to a pre-colonial-era genealogical database, and I was absolutely haunted by how many men had two, three, four wives—and this was the elite of pre-Revolutionary America. I could never bear to do a serious count, but an educated guess is that probably half the wives of those men died either in childbirth, of complications of pregnancy like pre-eclampsia, or of complications of childbirth. The men, of course, were all named. Many of their wives were not. They were impregnated and bred—married women had no right to their own bodies; sex was their marital duty—to death. Those women who didn’t die were often horribly injured during childbirth, whereupon their husbands often took a mistress or imposed themselves upon the female household help. (Those who say that husbands should not be present in the delivery room because it might lessen their libido miss the point that this is a natural and in fact desirable reaction to the suffering and even death that is the natural result of sexual intercourse. The woman, after all, must endure whether or not her man is their with her.) Then the widower, needing someone to run his house and care for his children, would marry another woman and repeat the process over again.

Yes, men died young. But there was absolutely no comparable vulnerability men had to women—and these men (for these people were of the Tory class) left some kind of mark upon their societies. Their names were all handed down in that database. They were not anonymous.

This dreadful interchangeability and anonymity is the social meaning we humans gave to the hideous biological fact of maternal mortality, and it lingers long after maternal mortality rates began to plummet in the developed world. It’s probably one reason so many early feminists of the 60s and 70s refused to have children. They grew up in a world where their mother and their female relatives had died or been grievously injured or had close friends who had or had been. In fact, it’s probably one major, if unspoken, reason that any woman who refuses to bear children does so. Another way to put it is, the human female body isn’t made to bear children. If our bodies were, we would give birth easily, at low risk, without public health measures such as sanitation and vaccination, pre- and post-natal care, medical intervention and supervision—to include both caesareans and abortions—and we simply don’t.

In the context of this biological reality, birth control that we can use—if need be without our male partner’s knowledge or permission—is one of the world’s great public health triumphs. Moreover, because morality is not a matter of “God says” or “It is written” or “In the name of Allah”—for God is neither a citizen nor a human being—but the reduction of unnecessary suffering and harm borne by other human beings and yes, animals, the availability and indeed provision of such birth control to women and adolescent girls is a profoundly moral thing.

The most common and effective type of birth control that a woman or adolescent girl can use herself—again if need be without male knowledge or permission—is birth control pills (BCPs). And even if some BCPs are $8 or 9 a pack in America, that does not mean that others are not $100 a pack. Sometimes the difference is one of advertising but often it’s not. Like hormone replacement therapy, BCPs use synthetic and natural anabolic steroids that are far more powerful than testosterone to intervene, regulate and control a hormone cycle that is more complex than the male. Getting dosage and timing wrong can be, to put it very mildly, extremely unpleasant, while working with an experienced doctor or nurse practitioner can minimize or eliminate the unpleasantness, even misery if an inappropriate prescription. If an $8-9 pack of BCPs works for you, great. If it doesn’t, we still need birth control that works for us.

This is because sex—including sexual intercourse—like food and shelter, is a basic human need, so deep that it can override even a woman’s need to live, rather than a male need women exist to satisfy. For women to have sex—including sexual intercourse—voluntarily with partners we want and enjoy, and controlling our fertility ourselves, without fear of an unwanted—for whatever reason—pregnancy is, then, profoundly moral. Unfortunately, all too many women and girls have sex all too often under conditions of manipulation and coercion that, if the law recognized as force what women and girls perceive as force when it used against us, would be considered rape. At the same time, prostitution and pornography are multi-billion dollar industries predicated upon extraordinarily violent crime—and defended as freedom of choice, commerce, and speech. And even when women and girls have sex under conditions of authentic, meaningful consent, and—if women—are physically and emotionally capable of motherhood, having a child changes and limits our lives in the way it does not a man’s life.

Because the bond between mothers and children for all of human history until half a century ago—less than an eyeblink—was not labor and delivery or nursing, but death. The value of our lives and our intellect is still circumscribed by the deep memory that the warrant for our deaths was signed at menarch, and to give one’s daughter in marriage was to give her to the man who might kill her. If sex, particularly sexual intercourse, was used as a means of dominance and control, even unto death by abortion or in childbirth, a man who loved his woman lived with the terrible knowledge that the sex and the child she, too, wanted might kill her, and if so, he was the instrument of her death—and very likely, their child’s as well.

These, then, are the reasons women and adolescent girls need access to birth control: because freedom begins with the body. Ask any slave whether it doesn’t. This is true for men, and no one would deny that a man or boy who cannot control his body is free. But it is even truer for women. For all the horrible, hideous things done to the male body—whether by criminals, the enemy in war, or the state—the perpetrators are usually other men and men are not usually controlled by sexual and reproductive means or for those purposes. Sex and reproduction, however, are the dominant and pervasive means of and excuse for controlling women and girls; this control is uniquely intimate, often astoundingly violent even in comparison to the violence done to men by other men, and has lifelong consequences. Finally, calling a woman a slut and a prostitute (as Ms. Fluke was called) has traditionally been used to justify any sexual violence (or non-sexual violence during the course of a sexual attack) visited upon a woman.

The vote may have given women a say in their lives, and modern medicine saved their lives wholesale, but it is access to contraception that frees women from the tyranny of reproduction and reproductive control.

So then, to answer my friend’s question, what does what remains of the Republican Party get out of fighting women’s access to birth control?

Cruelty. Knowing, deliberate cruelty towards women—half the species. (The opposition to renewing the Violence Against Women Act is more of the same.) Mothers, sisters, lovers, wives, friends. The only way that birth control on our own behalf as individuals as a fundamental right is debatable is if you think women should not be able to control our fertility ourselves, without the permission of anyone else. If you want to debate that, then do so on the grounds of the facts outlined above, rather than demonstrably false claims of morality or religious freedom.

The arguments against birth control are usually made by extremely privileged men to mostly men but also some women, who are profoundly hurt, angry, and humiliated—and not nearly as privileged. Their audience is that group of Americans who have a little left to lose, and can see themselves losing it, and react by wanting to hurt others whom it is safe to hurt. How can you hurt the big corporations and banks/financial institutions that have destroyed your work and your savings—who fund these extremely privileged men—who are campaigning for the Republican nomination and then the Presidency—who don’t have the slightest intention of biting the hand that funds their campaigns and lifestyles? The fact is that the Personhood Pledge, to which Romney, Santorum, Gingrich and Paul are all signatories, is the closest the Republican Party comes to a comprehensive jobs program. Leaving aside the practical matter of passing an amendment that defines personhood as occurring at the moment of conception is the brutal insult and diminution of women. To equate an undifferentiated cluster of cells with the female individual it exists inside and cannot possibly exist without means that that cluster of cells matters more than her dreams, fears and hopes. She is reduced to a host whether her pregnancy is longed-for and anticipated or a heart-breaking catastrophe. And this Pledge pretends that if women were once again subject to the tyranny of reproduction and childcare, their life options dependent on what the men in their lives choose to permit them, all would be well for men and women too.

A quick look at any society in the world where this is true should disabuse one of this notion. Afghanistan is just one case in point: the fact is that what we learn in the home becomes normal to us. We take it out into the world and it informs how we treat others and how we expect to be treated. Another way to say this is that real democracy cannot exist without women’s self-control and reproductive freedom. Because we are half of society and what happens to us profoundly effects that society.

What the Republican Party gets out of the screeching over contraception is an offer of something evil and ugly to men—and to the women who want to be their enforcers. The possibility of real, lasting control over the women in their lives, particularly their sexual partners, as well as a sop to their pride, in the offer of unearned moral authority at the real expense of others.

In the framework of the facts above, the attempt to withhold contraception from as many women as possible—whether it is employers refusing to provide contraceptive coverage or refusing to fund Planned Parenthood or pharmacists refusing to fill prescriptions or make Plan B available—is, at the most basic, profound and intimate level, about pitting men and women against each other as a way to defuse male anger and female humiliation at seeing other women live happier, less painful lives. Instead of sex, including sexual intercourse, being about mutual pleasure and affection, a bond between two human beings, it makes sex and particularly sexual intercourse a way a man imposes fear and pain and injury upon a woman even if she wants him, even if he loves her—and if he wants to, a way to use sex against a woman to revenge himself for the hurt and pain his political elites have imposed upon him. It is a safety valve meant to keep these men and women uniting against a profoundly unjust economic order.

But there is also something else people, particularly women, get out of this. And that is the same thing people do anywhere who behave this way, be they Muslim or Jewish fundamentalists or whether religion is involved at all. If your memory is long enough, think of all those members of politically extreme movements who happily abnegated their freedom for the “greater good,” whether the Volk or the Reich or the classless society. Think of Darkness at Noon and victories for the Islamists in Egypt. What we are seeing is an escape from freedom, whether their own freedom and happiness or having to deal with the freedom and happiness of others. And yes, the uproar about women’s access to contraception as a basic public health need—and right—is about freedom at its most basic and elemental: that a female should not have to become pregnant and give birth unless she wants to. Because having sexual intercourse isn’t wrong—much less a crime worthy of involuntary labor and great pain, often serious injury and sometimes death, be it in abortion or childbirth. Indeed, we rarely punish incest and rape so harshly.

Once upon a time, the Republican Party had a rationally different point of view from the Democratic Party, and both parties shared certain goals. This is no longer true: the Republican Party is slowly, deliberately purging itself of those who can legitimately be called conservative. Which is also to say, the sane, the rational and the humane. The party ceased to have room for Mr. Conservative, Barry Goldwater, who was light-years ahead of his time about women’s rights, civil rights, gay rights, the environment, long ago. His ideas are no longer even a figleaf and if his soul knows what is happening to his beloved Republic and his Party, he is in agony.

Now the Republican Party now exhibits an interesting conundrum. It advocates for massive defense spending on behalf of American security, while arguing against Americans being healthy by having access to health care—or even being free of the deadly tyranny of reproduction by having access to contraception. It stresses individual liberty while sponsoring bills that would permit employers to refuses to provide insurance coverage for birth control for “moral or religious reasons” unless a woman provided proof she was using birth control for “other purposes.” It stresses morality while turning sexual intercourse into an exercise of dominance and infliction of pain and fear and humiliation—the rapist’s ethos—even between people who love and want each other. Its “traditional family values” show that its real values are not people who love each other and commit to each other—otherwise it would embrace gay marriage—but dominance and cruelty. It claims to embrace freedom of religion yet freedom of religion means my freedom from your religion—even if I am your employee and you are the Pope himself—especially when it comes to something so personal, dangerous and permanent as pregnancy and childbirth or abortion. Belief in the Nicean creed is one thing. Eliminating basic medical care, which contraception—like blood transfusions, which were in fact first developed to save women from dying in childbirth—is, from health insurance, is something else.

And all of this will still be true no matter who the Republican nominee is.

Time was I thought that Iran would be the first nuclear power governed by men using religion and the possibility of engaging in sexual cruelty to twist and control their nation. Now, I’m not so sure.